Can diclofenac (nonsteroidal anti-inflammatory drug (NSAID)) be given to a 14-year-old boy?

Diclofenac Use in a 14-Year-Old Boy

Diclofenac can be safely administered to a 14-year-old boy as it is considered compatible with use in pediatric patients of this age, though it is not FDA-approved for all pediatric indications. 1

Evidence-Based Recommendation

Diclofenac is an effective NSAID that has been studied and used in pediatric populations. The evidence supports its use in adolescents with the following considerations:

• According to the 2020 Anaesthesia guideline, diclofenac is considered safe to use during breastfeeding, indicating its general safety profile, though it notes it's not FDA or EMA approved for all pediatric uses 1
• The 2025 PANLAR guidelines for juvenile idiopathic arthritis state that "diclofenac is not FDA or EMA approved for pediatric use, it can be considered at the discretion of the treating physician based on clinical experience" 1
• A Cochrane review concluded that diclofenac is an effective analgesic for perioperative acute pain in children with rare serious adverse reactions similar to those in adults 2

Dosing Recommendations

For a 14-year-old boy, the following dosing is recommended:

• Single dose: 0.5-1 mg/kg every 8 hours based on pharmacokinetic studies 3
• Maximum daily dose should not exceed 150 mg total 4
• For acute pain management, a single 50-mg dose has been studied in adolescents 12-17 years with favorable pharmacokinetic and safety profiles 5

Safety Considerations

When administering diclofenac to a 14-year-old, monitor for:

1. Gastrointestinal effects: Most common adverse effects, though less severe than with aspirin or indomethacin 4
2. Cardiovascular risk: While this is more relevant for long-term use in adults with risk factors, be aware of potential cardiovascular effects 6
3. Renal function: Consider monitoring renal function if used for extended periods 6

Clinical Context

Diclofenac is commonly used by pediatric anesthesiologists in children, including those under 14 years of age:

• A survey of pediatric anesthesiologists found that 86% use NSAIDs in infants, with diclofenac being the most commonly used intraoperatively (78%) 7
• Diclofenac has been shown to reduce the need for post-operative rescue analgesia compared to placebo (RR 0.6) 2

Common Pitfalls and Caveats

1. Age-appropriate formulation: Ensure the formulation is suitable for the adolescent patient
2. Duration of treatment: Limit to shortest duration necessary for symptom control
3. Concomitant medications: Be cautious with other medications that may interact with diclofenac
4. Hydration status: Ensure adequate hydration to minimize renal effects
5. Pre-existing conditions: Screen for asthma, bleeding disorders, or renal impairment before administration

In conclusion, diclofenac is an appropriate analgesic option for a 14-year-old boy when used at appropriate doses and with proper monitoring. While not FDA-approved for all pediatric indications, clinical experience and available evidence support its use in this age group.